Emergency and Critical Care Center, Mie University Hospital, Edobashi 2-174, Tsu, Mie Japan.
J Intensive Care. 2015 Jul 21;3(1):33. doi: 10.1186/s40560-015-0098-z. eCollection 2015.
Extracorporeal cardiopulmonary resuscitation (ECPR) is being used increasingly in the emergency and critical care field in Japan. A major complication of ECPR is bleeding; however, the optimal initial heparin dose and activated coagulation time (ACT) remain unknown. The aim of this study was to assess the appropriateness of our initial anticoagulation protocol.
We retrospectively evaluated the initial heparin dose, ACT value, and incidence of bleeding and thrombotic complications in post-cardiopulmonary arrest patients who received a fixed, body weight-unadjusted loading dose of unfractionated heparin (3000 U) prior to veno-arterial extracorporeal membrane oxygenator (ECMO) between February 2011 and November 2013 at Mie University Hospital, Japan.
ACT was evaluated within 3 h of initiation of 32 consecutive ECPR patients. The mean heparin dose per body weight was 53.6 U/kg and the mean ACT was 231.3 s. In 17 patients, ACT exceeded 200 s. Three patients experienced fatal bleeding in the chest wall within 24 h of receiving ECMO. The mean heparin dose per kilogram body weight, mean initial ACT, and mean duration of cardiopulmonary resuscitation (CPR) did not statistically differ between the patients who experienced fatal bleeding and those who did not.
Fixed-dose heparin of 3000-U bolus resulted in a mean heparin dose per kilogram body weight of 53.6 U/kg and an ACT of 231.3 s and experienced 3 out of 32 fatal bleedings. Further researches are warranted to optimize anticoagulation protocol for ECPR patients.
体外心肺复苏（ECPR）在日本的急救和重症监护领域的应用越来越多。ECPR 的主要并发症是出血；然而，最佳的初始肝素剂量和激活凝血时间（ACT）仍不清楚。本研究旨在评估我们初始抗凝方案的适宜性。
我们回顾性评估了 2011 年 2 月至 2013 年 11 月期间在日本三重大学医院接受静脉-动脉体外膜氧合（ECMO）前给予固定、未调整体重的普通肝素（3000U）负荷剂量的心肺复苏后患者的初始肝素剂量、ACT 值以及出血和血栓并发症的发生率。
在 32 例连续接受 ECPR 的患者中，在开始治疗后 3 小时内评估了 ACT。每公斤体重的平均肝素剂量为 53.6U/kg，平均 ACT 为 231.3s。在 17 例患者中，ACT 超过 200s。3 例患者在接受 ECMO 后 24 小时内发生致命性胸壁出血。发生致命性出血的患者与未发生致命性出血的患者的每公斤体重肝素剂量、初始 ACT 均值和心肺复苏（CPR）持续时间均无统计学差异。
3000U 负荷剂量的普通肝素导致每公斤体重肝素剂量为 53.6U/kg，ACT 为 231.3s，32 例患者中有 3 例发生致命性出血。需要进一步研究来优化 ECPR 患者的抗凝方案。
